Activities of Daily Living: Tips for the Family Caregiver

Activities of daily living (ADLs) are the everyday activities
involved in personal care such as feeding, dressing, bathing,
moving from a bed to a chair (also called transferring), toileting
and walking. Physical or mental disabilities can restrict a
person's ability to perform personal ADLs. It is extremely
difficult to depend on another person to perform these basic tasks.
It can also be difficult for the new caregiver to undertake these
tasks for a loved one. When a friend or family member becomes
disabled, the inclination of the caregiver is to over-care.

Caregivers will almost always benefit from learning:

The significance of ADLs in the world of caregiving,

What type of ADL care is needed in a specific caregiving
scenario, and

How to perform ADL care appropriately to meet the unique needs
of your loved one.

Significance of ADLs

"Activities of daily living" is a commonly used term in the
health care and professional caregiving world to describe a
person's ability to care for him or herself. Often the ability or
inability to perform specific ADLs is used as qualifying criteria
for special services or programs. For example, services that
measure ADLs as a part or all of their eligiblity criteria
include:

Adult Day Care Centers

Assisted Living

Home Health Agencies

Nursing Homes and

Hospice

As a caregiver you should ask the health care professionals in
your life to tell you how they use ADLs to determine eligibility
for services or to make a plan of care.

Types of Care

In evaluating an individual, a plan of care must be developed
that allows for meeting both the physical and psychosocial needs of
the care recipient. There are two types of goals associated with a
plan of care: rehabilitative and
habilitative.

If the inability to provide self-care is the result of a health
crisis such as a stroke, the care recipient may be totally
dependent and require assistance with all ADLs. However, this
dependence may be temporary and there may be an excellent prognosis
for full or partial recovery. In such cases, the plan of care is
rehabilitative with the goal of restoring
independence.

Some diseases, such as dementia of the Alzheimer's type, cause a
gradual loss of the ability to provide self-care. The plan of care
in such cases is then habilitative with the goal of
helping the person to function at their highest level.

Caregiver Tips for ADL Care

Evaluate the severity of the condition and develop a plan. It is
difficult to predict the long-term effects of an event such as a
stroke or of Alzheimer's disease. The first decision to be made is:
Who is the caregiver? Families may be unable to provide the needed
care. With the guidance of the health care professionals families
must answer this question. Next, they must be educated about what
care is needed and how to provide it. Families need this
information even if they will not be the direct caregiver, as they
will be the most important partner of the health care
professional.

Help only when help is necessary.
This often presents the greatest challenge. We all have been
conditioned to see people who are unable to care for themselves as
sick. We confine them to bed and do for them what they can in fact
do for themselves. While acceptable in early life, this type of
care can be the death knell for an older person. Even short periods
of confinement can result in serious muscle loss and weakness.

Break big tasks into smaller tasks.
If the plan is rehabilitative, as with a stroke, the care recipient
may be overwhelmed by the inability to perform simple tasks.
Depression, fear and humiliation are major obstacles. If tasks are
too complex, the care recipient may feel frustrated and defeated.
If the care is habilitative, as with dementia, the care recipient
may have permanently lost the ability to complete complicated
tasks. Presenting the care recipient with such tasks can result in
angry, even violent outbursts that can result in injury to the
caregiver.

Encourage movement and exercises.
This is essential in rehabilitative and habilitative care. Mobility
increases independence and decreases complications due to
inactivity. Exercises that put the major muscle groups through the
full range of motion (ROM) must be encouraged. If the care
recipient is unable to do ROM exercises independently, then these
must be done passively. This means that the caregiver moves the
affected limb through the ROM. It is important to remember that
even the smallest efforts, if done consistently, will lead to
greater independence. Complications of immobility include muscle
wasting, pneumonia, constipation, edema (swelling), pressure
ulcers, urinary problems, osteoporosis, and blood clots.

Provide training as needed. Regaining
lost abilities or learning new ways of doing things is never easy.
Caregivers must first learn what to do and how to do it. Then they
must teach their care recipient. It may be easier and quicker for
the caregiver to perform the task, but this temptation must be
resisted. Over caring for someone can result in severe, even
permanent physical and psychological harm. Even though someone may
not be able to bathe their own body completely - a wash cloth and
encouragement can go a long way to maintaining dignity and some
sense of control. Being able to accomplish bathing his or her own
face can be a major triumph for a person recovering from a
stroke.

Encourage the use of assistive
devices. Mobility aids include wheelchairs, canes and
crutches and walkers. Sensory assistive devices include: vision
aids, hearing aids and dentures. Other assistive devices include
everything from uniquely designed eating utensils, to special
devices that facilitate enjoyment of hobbies such as reading,
playing music and gardening. These devices encourage independence.
Physical Therapists and Occupational Therapists are specially
trained health professionals who can teach care recipients and
caregivers about these devices and how to use them correctly.

Recognize the need for dignity. Care
must be provided in a manner that preserves dignity. The
humiliation of losing the ability to self-toilet can be worsened by
insensitive care. Closing doors, avoiding excessive exposure,
allowing choice and participation in care is essential. Frequent
clothing changes for people who are incontinent is critical. Daily
shaves, frequent manicures, and regular visits to the hairdresser
can also contribute to the care recipient's sense of well being.
Encouraging independence is important, as is knowing how to
intervene when the care recipient's attempts at self-care are
inadequate.

Recognize changes in skin condition.
The skin is the largest organ of the human body and the condition
of the skin is a barometer of health. Dry skin is a normal part of
aging. Keeping the skin clean (using oil-based cleansers) and well
lubricated is especially important for the care recipient who has
lost mobility. Caregivers must assist the care recipient with
frequent position changes if the care recipient is unable to do so
independently. Skin should be examined regularly for signs of
pressure, especially on the bony parts of the body. If pressure is
not relieved, bedsores (pressure ulcers) can form. If left
untreated these ulcers can penetrate through the skin, into the
muscle and bone. Pressure ulcers are extremely painful and often
require surgical repair.

Monitor nutrition closely. Eating a
well-balanced diet is especially important for people who are very
ill. Two common, serious hindrances to good nutrition are
difficulty swallowing and problems with chewing. Food may need to
be pureed and liquids thickened to facilitate swallowing and to
prevent choking. Care recipients with dementia may have a greater
caloric need. Serving six small meals is often preferable to the
traditional three meals per day. Also, speak with your health care
professional about the benefits of a nutritional supplement.

Provide for psychosocial needs. Care
recipients who are ill or disabled have an increased need for
acceptance from family, friends and care providers. Entertainment
and social interaction are essential to all of us; especially if we
are recovering from an illness or living with a deteriorating
health condition. Caregivers should observe closely for signs of
withdrawal and isolation. Care recipients with dementia often
benefit from activities such as music and reminiscence therapy.
Reminiscence therapy is remembering the past by looking at pictures
or talking about different events.